Spontaneous dyskinesia and Parkinsonism in never-medicated, chronically ill patients with schizophrenia: 18-month follow-up
McCreadie RG, Padmavati R, Thara R, Srinivasan TN;
Commented by , 19 Aug 2002
Aim of the study
There is a considerable amount of evidence that movement disorders need not only be induced by treatment with antipsychotic drugs. They sometimes seem to be an expression of the schizophrenic illness itself. Thus, spontaneous dyskinesia and Parkinsonism have been reported in never-medicated patients with schizophrenia but there has been no previous study of the long-term course of these conditions.
Therefore the authors examined the prevalence of spontaneous dyskinesia and Parkinsonism in a group of never-medicated, chronically ill patients with schizophrenia on two occasions separated by an 18-month interval.
Method
The study was conducted at the Schizophrenia Research Foundation in India. All patients fulfilled DSM—IV criteria for schizophrenia. The patients' lifetime exposure to medication was determined from several sources which include discussion with patients and relatives, and examination of case records and prescription sheets. By this it was confirmed that none of the patients had ever received antipsychotic medication.
Dyskinesia was assessed by the Abnormal Involuntary Movements Scale using Schooler and Kane criteria for its presence; parkinsonism by the Simpson and Angus scale; and mental state by the Positive and Negative Syndrome Scale for schizophrenia.
The initial group consisted of 108 patients who were then tried to trace and reassess 18 months later. All patients and families who participated consented to participate in the study.
Results
At the follow-up after 18 months 8 out of the initial group of 108 patients were dead and 36 had received antipsychotic medication. Twenty-seven could not be traced. Thirty-seven patients could be examined on two occasions. The mean age of these patients was 52 years and their mean length of illness was 17 years. 16 (43%) were men and 21 (57%) women.
Nine (24%) had dyskinesia on both occasions, 12 (33%) on one occasion and 16 (43%) on neither occasion. Twenty-one (57%) had dyskinesia on at least one occasion. Thirteen patients (35%) had Parkinsonism on at least one occasion.
Discussion
The authors discuss these finding in keeping with previous research that movement disorders may be an integral part of the disease process and that sometimes they do not need to be drug-related. Furthermore, spontaneous dyskinesia and Parkinsonism can fluctuate over time.
The main limitations of the study were that only a third of the patients originally identified could be re-examined 18 months later, and that it was overall a middle aged-group. Therefore, the patterns could differ in younger patients.